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LaBarge ME, Shirely Z, Rodgers J, Kuhn AW, Martus JE, Riccio AI. Dysplasia Epiphysealis Hemimelica in the Lower Extremity. J Pediatr Orthop 2023; 43:e481-e486. [PMID: 36998171 DOI: 10.1097/bpo.0000000000002406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
BACKGROUND Because of the rarity of dysplasia epiphysealis hemimelica (DEH), little is known about the relationship between disease classification and clinical symptoms or patient outcomes. This studies therefore aims to characterize DEH of the lower extremity and correlate radiographic classification to presenting symptomatology and need for surgical intervention. METHODS A multi-center, retrospective review of all patients with DEH of the lower extremity over a 47-year period was conducted. Demographic data, presenting complaints, treatments, and symptoms at final follow-up were recorded. Radiographs were reviewed to classify lesions using the Universal Classification System for Osteochondromas (UCSO) and document the presence of solitary or multiple lesions within the involved joint. Correlative statistics were used to determine whether presenting complaints, lesion location or radiographic classification predicted the need for surgery or a pain-free outcome. RESULTS Twenty-eight patients met inclusion criteria with an average age at presentation of 7.8 years. The ankle was the most commonly affected joint with 20/28 patients (71%) having lesions of the talus, distal tibia, or distal fibula. Patients with chief complaints of pain were more likely to undergo surgery than those with complaints of a mass or deformity ( P =0.03). Ankle lesions were more likely to be managed operatively than those of the hip or knee ( P =0.018) and all 12 patients with talar lesions underwent surgery. Neither the number of lesions nor lesion classification was predictive of surgical intervention or a pain-free outcome after surgery. Patients presenting with pain were more likely to have a pain-free outcome (11/14 patients) after surgery ( P =0.023) whereas all patients presenting with deformity who underwent surgery had pain at final follow-up. CONCLUSIONS Although no single radiographic characteristic of DEH was predictive of surgical intervention or outcome, painful lesions of the ankle, and lesions of the talus were more likely to be managed operatively. Although surgery does not always result in a pain-free outcome, the operative management of painful lesions was more likely to provide a pain-free outcome than surgery for deformity or a mass.
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Hajjar C, Haloua M, Bouardi NE, Alami B, Lamrani MYA, Maaroufi M, Boubbou M. Hemimelic epiphyseal dysplasia: a case report. Radiol Case Rep 2022; 17:2277-2282. [PMID: 35515508 PMCID: PMC9062141 DOI: 10.1016/j.radcr.2022.03.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 11/28/2022] Open
Abstract
Hemimelic epiphyseal dysplasia HED also known as Trevor's disease is a rare pathology, characterized by a developmental disorder of an internal or external half of one or more epiphyses of a limb, mainly the lower limb, and/or of the short tarsal bones in children and young adolescents, with a male predominance. Its etiology remains unclear. Its clinical symptomatology is variable, ranging from asymptomatic involvement to orthopedic complications such as limb length inequality. As the clinic is non-specific, radiological assessment is the essential diagnostic tool for Trevor's disease, including standard radiography, MRI, CT, and possibly biopsy in some cases. The radio clinical signs make it possible to establish the diagnosis, even if it remains difficult because of the rarity of the disease and the presence of multiple differential diagnoses which are often better known such as osteochondroma and exostosis. After diagnostic confirmation, the therapeutic decision remains debated, ranging from simple observation to surgical excision. The prognosis of HED remains good, given the absence of the risk of malignant transformation. Post-therapeutic complications are dominated by recurrence or the appearance of secondary osteoarthritis. Objective: This clinical case challenges us to keep in mind the hemimelic epiphyseal dysplasia (HED) in front of a mass that originates at the level of the internal or external half of one or more epiphyses in children.
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Affiliation(s)
- Chaymae Hajjar
- Department of mother and children's radiology of Fez, CHU Hassan II, Sidi Mohamed Ben Abdellah University Fes, Fes, Morocco
- Corresponding author.
| | - Meriem Haloua
- Department of mother and children's radiology of Fez, CHU Hassan II, Sidi Mohamed Ben Abdellah University Fes, Fes, Morocco
| | - Nizar El Bouardi
- Radiology department of Fez, CHU Hassan II, Sidi Mohamed Ben Abdellah University Fes, Fes, Morocco
| | - Badreeddine Alami
- Radiology department of Fez, CHU Hassan II, Sidi Mohamed Ben Abdellah University Fes, Fes, Morocco
| | | | - Mustapha Maaroufi
- Radiology department of Fez, CHU Hassan II, Sidi Mohamed Ben Abdellah University Fes, Fes, Morocco
| | - Meriem Boubbou
- Department of mother and children's radiology of Fez, CHU Hassan II, Sidi Mohamed Ben Abdellah University Fes, Fes, Morocco
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Ionescu A, Popescu B, Neagu O, Carp M, Tevanov I, Balanescu L, Balanescu RN. Dysplasia Epiphysealis Hemimelica (Trevor's Disease) in Children, Two New Cases: Diagnosis, Treatment, and Literature Review. CHILDREN-BASEL 2021; 8:children8100907. [PMID: 34682172 PMCID: PMC8600412 DOI: 10.3390/children8100907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/02/2021] [Accepted: 10/06/2021] [Indexed: 11/16/2022]
Abstract
Dysplasia epiphysealis hemimelica (DEH), also known as Trevor’s disease, is a rare nonhereditary skeletal disorder affecting one side of the epiphyses or the epiphyses-equivalents. It is often misdiagnosed for traumatic injuries, infections, or other tumors because of the nonspecific clinical features. The diagnosis is mostly based on radiographic involvement of one half of the epiphysis displaying an overgrowth; it is hard to distinguish between DEH and osteochondroma on the gross hystopathological exam. There are few immunohistochemical markers, as well as genetic tests, for EXT1 and EXT2 gene expression that can reveal a more accurate diagnosis. No evidence of malignant changes has been reported and no hereditary transmission or environmental factor has been incriminated as an etiological factor. The natural history of the disease is continuous growth of the lesions until skeletal maturity. Without treatment, the joint might suffer degenerative modification, and the patient can develop early onset osteoarthritis. In the present paper, we report two new cases of DEH of the ankle. The aim of this paper is to consider Trevor’s disease when encountering tumoral masses in the epiphyses of pediatric patients and to present our treatment approach and results.
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Affiliation(s)
- Adelina Ionescu
- Department of Pediatric Orthopedic Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (A.I.); (B.P.); (I.T.)
| | - Bogdan Popescu
- Department of Pediatric Orthopedic Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (A.I.); (B.P.); (I.T.)
| | - Oana Neagu
- Department of Pathology, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania;
| | - Madalina Carp
- Department of Pediatric Orthopedic Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (A.I.); (B.P.); (I.T.)
- Correspondence: or ; Tel.: +40-21-316-93-72
| | - Iulia Tevanov
- Department of Pediatric Orthopedic Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (A.I.); (B.P.); (I.T.)
| | - Laura Balanescu
- Department of Pediatric Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (L.B.); (R.N.B.)
- Department of Pediatric Surgery and Orthopedics, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | - Radu Ninel Balanescu
- Department of Pediatric Surgery, “Grigore Alexandrescu” Clinical Emergency Hospital for Children, 011743 Bucharest, Romania; (L.B.); (R.N.B.)
- Department of Pediatric Surgery and Orthopedics, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
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Vashisht S, Aggarwal P, Bhagat R, Garg A, Gupta PN, Garg SK. Dysplasia Epiphysealis Hemimelica (Trevor Disease) of the Patella: A Case Report. JBJS Case Connect 2021; 10:e2000003. [PMID: 32865949 DOI: 10.2106/jbjs.cc.20.00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report a rare case of dysplasia epiphysealis hemimelica in an 11-year-old male child involving the patella. The patient noticed swelling in the right knee 6 months before presentation. On evaluation, there was a mass lesion originating from superior pole of the patella extending into the suprapatellar pouch. On opening the knee joint, it was found to be mainly cartilaginous in nature. Surgical excision of the mass was carried out. CONCLUSION Trevor disease should be considered in the differential diagnosis of a mass originating from the patella in children. The recommended treatment is complete excision of the mass.
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Affiliation(s)
- Saurabh Vashisht
- 1Department of Orthopaedics, Government Medical College & Hospital, Chandigarh, India 2Department of Radiodiagnosis & Imaging, Government Medical College & Hospital, Chandigarh, India 3Department of Pathology, Government Medical College & Hospital, Chandigarh, India
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Won SH, Kim J, Min TH, Chun DI, Yi Y, Han SH, Cho J. Tarsal tunnel syndrome secondary to osteochondroma of the calcaneus: a case report. BMC Musculoskelet Disord 2020; 21:491. [PMID: 32711480 PMCID: PMC7382807 DOI: 10.1186/s12891-020-03530-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/21/2020] [Indexed: 11/12/2022] Open
Abstract
Background Tarsal tunnel syndrome is an entrapment neuropathy that can be provoked by either intrinsic or extrinsic factors that compresses the posterior tibial nerve beneath the flexor retinaculum. Osteochondroma, the most common benign bone tumor, seldom occur in foot or ankle. This is a rare case of tarsal tunnel syndrome secondary to osteochondroma of the sustentaculum tali successfully treated with open surgical excision. Case presentation A 15-year-old male presented with the main complaint of burning pain and paresthesia on the medial plantar aspect of the forefoot to the middle foot region. Hard mass-like lesion was palpated on the posteroinferior aspect of the medial malleolus. On the radiological examination, 2.5 × 1 cm sized bony protuberance was found below the sustentaculum tali. Surgical decompression of the posterior tibial nerve was performed by complete excision of the bony mass connected to the sustentaculum tali. The excised mass was diagnosed to be osteochondroma on the histologic examination. After surgery, the pain was relieved immediately and hypoesthesia disappeared 3 months postoperatively. Physical examination and radiographic examination at 2-year follow up revealed that tarsal tunnel was completely decompressed without any evidence of complication or recurrence. Conclusions As for tarsal tunnel syndrome secondary to the identifiable space occupying structure with a distinct neurologic symptom, we suggest complete surgical excision of the causative structure in an effort to effectively relieve symptoms and prevent recurrence.
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Affiliation(s)
- Sung Hun Won
- Department of Orthopaedic Surgery, Bone & Joint center, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Jahyung Kim
- Department of Orthopaedic Surgery, Seoul Hospital, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Tae-Hong Min
- Department of Orthopaedic Surgery, Seoul Hospital, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Dong-Il Chun
- Department of Orthopaedic Surgery, Seoul Hospital, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Young Yi
- Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University, Seoul, Republic of Korea
| | - Sang Hak Han
- Department of Pathology, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, Republic of Korea
| | - Jaeho Cho
- Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 200-704, Republic of Korea.
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TKA in the treatment of bilateral dysplasia epiphysealis hemimelica (Trevor's Disease) of the knee in a 50-year-old man: a case report. BMC Musculoskelet Disord 2020; 21:167. [PMID: 32171273 PMCID: PMC7071648 DOI: 10.1186/s12891-020-3146-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 02/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dysplasia epiphysealis hemimelica (DEH), also known as Trevor's disease, is a rare skeletal developmental disorder affecting the epiphyses in pediatric patients. DEH is characterized by an asymmetric osteochondral overgrowth arising from either the medial or lateral portion of an epiphysis and usually occurs in the joints of lower limbs, most commonly in the knees and ankles. However, bilateral involvement in an adult is extremely rare, and total knee arthroplasty (TKA) for a patient with DEH has been reported only once before. CASE PRESENTATION Here, we present a case of bilateral DEH of the knees that caused varus deformity and dysfunction of the lower limbs in a 50-year-old man. TKA was performed for treatment, and the patient had satisfactory function with no angular knee deformity and a normal range of motion after 1 year of follow-up. CONCLUSIONS The patient in this case exhibited its specific clinical and radiological features of late-term DEH and TKA was proved to be an appropriate procedure for treating the severe deformity caused by this rare disease.
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Shahcheraghi GH, Javid M. Dysplasia Epiphysealis Hemimelica Can Be Controlled by Growth Modulation: A Case Report. JBJS Case Connect 2020; 10:e0353. [PMID: 32224672 DOI: 10.2106/jbjs.cc.19.00353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CASE Dysplasia epiphysealis hemimelica (DEH), or Trevor disease, is an abnormal nonmalignant overgrowth of the epiphysis on one side of the body, often confined to one half of a joint of a limb. There is no known etiology or treatment for it. We are reporting the case of a 4.5-year-old boy with osteochondral-like growths on one side of the knee and ankle that could not be controlled by repeated excision. He underwent epiphyseal stapling at the knee and ankle. The regrowth was halted in both locations and has lasted for over 8 years. CONCLUSION Modulation of physeal growth by stapling can halt the uncontrollable overgrowth of lesions in DEH.
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Affiliation(s)
- Gholam Hossain Shahcheraghi
- Department of Orthopaedic Surgery, Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahzad Javid
- Department of Orthopaedic Surgery, Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Jang E, Danford NC, Levin AS, Tyler WK. Intra-Articular Tumors: Diagnosis and Management of the Most Common Neoplasms Involving Synovial Joints. JBJS Rev 2018; 6:e8. [PMID: 30589749 DOI: 10.2106/jbjs.rvw.17.00210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Eugene Jang
- Department of Orthopaedic Surgery, Columbia University Medical Center/NY-Presbyterian Hospital, New York, NY
| | - Nicholas C Danford
- Department of Orthopaedic Surgery, Columbia University Medical Center/NY-Presbyterian Hospital, New York, NY
| | - Adam S Levin
- Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Wakenda K Tyler
- Department of Orthopaedic Surgery, Columbia University Medical Center/NY-Presbyterian Hospital, New York, NY
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More Than Epiphyseal Osteochondromas: Updated Understanding of Imaging Findings in Dysplasia Epiphysealis Hemimelica (Trevor Disease). AJR Am J Roentgenol 2018; 211:910-919. [DOI: 10.2214/ajr.18.19712] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Uygur E, Demiroğlu M, Aydin D, Kiliç B, Özkan K. An unusual presentation of Trevor's disease at the ankle joint: Involvement of both medial and lateral epiphyses. Foot (Edinb) 2018; 36:55-58. [PMID: 30336340 DOI: 10.1016/j.foot.2018.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 01/11/2018] [Accepted: 01/15/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Trevor's disease, also known as dyplasia epiphysealis hemimelica, is characterised by osteochondromas arising from epiphyses. The disease typically affects one side of an epiphysis (usually the medial side). CASE PRESENTATION A case in whom both the medial and lateral sides of the epiphysis were involved is described. Thus, the use of the descriptor "hemimelica" is not always appropriate. CONCLUSION Although rare, Trevor's disease should be kept in mind during the differential diagnosis of patients with ankle pain and a mass. Other possible joints should be examined to explore multiple involvement. Surgical treatment, only on lesions causing impingements, may improve functional status and reduce pain.
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Affiliation(s)
- Esat Uygur
- İstanbul Medeniyet University Goztepe Training and Research Hospital, Orthopaedics and Traumatology Department, Turkey.
| | - Murat Demiroğlu
- İstanbul Medeniyet University Goztepe Training and Research Hospital, Orthopaedics and Traumatology Department, Turkey.
| | - Davut Aydin
- İstanbul Medeniyet University Goztepe Training and Research Hospital, Orthopaedics and Traumatology Department, Turkey.
| | - Bülent Kiliç
- İstanbul Gelişim University, 34310 Cihangir, Avcılar, İstanbul, Turkey.
| | - Korhan Özkan
- İstanbul Medeniyet University Goztepe Training and Research Hospital, Orthopaedics and Traumatology Department, Turkey.
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Abstract
Trevor's disease, also known as dysplasia epiphysealis hemimelica, is a rare nonhereditary skeletal development disorder that affects epiphyses. This type of dysplastic lesion was first reported by Mouchet and Berlot in 1926 under the name 'tarsomegaly'. The main aim of this study is to raise awareness of Trevor's disease among orthopedic surgeons and underline some important aspects of treatment by a detailed presentation of four different possible manifestations of the disease. Four different treatment methods were used on four different patients (three localized in hindfoot ankle region and one classic Trevor's disease case). Treatment methods, localization of the sides involved, different characteristics of entire lower extremity, asymetry, distal femoral lateral epiphysis involvement, and hip involvement were analyzed thoroughly and the results were compared with those found in the most recent literature. Of our four patients, three were localized (hind foot ankle) cases and one was a classic dysplasia epiphysealis hemimelica with hemimelic distribution of the entire lower extremity. We used arthroscopic resection, observation, excision, and temporary hemiepiphysiodesis treatment methods in each of our cases. Clinical follow-up results were reported to be between good and excellent. In sum, our opinion is that the treatment for this condition should be customized according to lesion localization and lesion size. Majority of cases with ankle involvement show good prognosis following excision. Observation is also an alternative in patients who refuse surgery. If an intra-articular lesion is present, the surgeon should perform an arthroscopy for assessment of lesion surface. If the lesion is adapted to the joint curvature, it should be left alone and hemiepiphysiodesis should be considered for correction. The most risky involvements that are related to deformities and limb-length discrepancies are the hip and the knee. This is usually the result of corrective osteotomy targeted at the supracondylar femoral area in immature skeletons. Hemiepiphysiodesis might be a more feasible option in those cases as it provides the surgeon with the choice to remove the staples when necessary.
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Khalsa AS, Kumar NS, Chin MA, Lackman RD. Novel case of Trevor’s disease: Adult onset and later recurrence. World J Orthop 2017; 8:77-81. [PMID: 28144583 PMCID: PMC5241549 DOI: 10.5312/wjo.v8.i1.77] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 08/18/2016] [Accepted: 10/18/2016] [Indexed: 02/06/2023] Open
Abstract
Dysplasia epiphysealis hemimelica (DEH), or Trevor’s disease, is an osteocartilaginous epiphyseal overgrowth typically occurring in children. The literature reports 6 adult cases and none describe recurrence requiring additional procedures. We present a new-onset proximal tibial DEH in an adult recurring approximately 3 years after open excision. A 39-year-old female presented with a history of right knee pain, swelling, and instability. Physical examination revealed a firm proximal tibial mass. Computed tomography (CT) imaging showed an exophytic, lobulated, sclerotic mass involving the anterolateral margin of the lateral tibial plateau. Magnetic resonance imaging was suggestive of an osteochondroma. The patient underwent curettage of the lesion due to its periarticular location. Histology revealed benign and reactive bone and cartilage consistent with periosteal chondroma. Two and a half years later, the patient presented with a firm, palpable mass larger than the initial lesion. CT revealed a lateral tibial plateau sclerotic mass consistent with recurrent intra-articular DEH. A complete excision was performed and histology showed sclerotic bone with overlying cartilage consistent with exostosis. DEH is a rare epiphyseal osteocartilaginous outgrowth frequently occurring in the long bones of children less than 8 years old. DEH resembles an osteochondroma due to its pediatric presentation and similar histologic appearance. Adult-onset cases comprise less than 1% of reported cases. Recurrence rate after surgical intervention is unknown. Only 1 such case, occurring in a child, has been described. Clinicians contemplating operative treatment for DEH should note the potential for recurrence and consider complete excision. A follow-up period of several years may be warranted to identify recurrent lesions.
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[An eight-year-old boy with painful flat feet]. Radiologe 2016; 56:917-920. [PMID: 27638820 DOI: 10.1007/s00117-016-0162-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jeon JY, Chung HW, Kwon JW, Hong SH, Lee GY, Ryu KN. Imaging findings of various talus bone tumors-clinico-radiologic features of talus bone tumors. Clin Imaging 2016; 40:666-77. [PMID: 27317211 DOI: 10.1016/j.clinimag.2016.02.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 02/18/2016] [Accepted: 02/22/2016] [Indexed: 12/12/2022]
Abstract
Osseous neoplasms of the foot are uncommon, accounting for only 3.3% of all primary bone tumors. Bone tumors of the talus are even rarer, and there are not many publications that comprehensively evaluate the imaging findings of talus tumors. The purpose of this article is to review the benign and malignant bone tumors affecting this uncommon site and to describe the clinical and radiologic features of each tumor.
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Affiliation(s)
- Ji Young Jeon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center
| | - Hye Won Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center.
| | - Jong Won Kwon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 135-710, Korea.
| | - Sung Hwan Hong
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Guen Young Lee
- Departments of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundanggu, Seongnam-si, Gyeonggi-do, 436-707, Korea.
| | - Kyung Nam Ryu
- Department of Radiology, Kyung Hee University Medical Center, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-702, Korea.
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Papamerkouriou YM, Orfanos I, Tsiridis E, Anastasopoulos J. Dysplasia epiphysealis hemimelica of the ankle: a fracture-like rare developmental disorder. BMJ Case Rep 2015; 2015:bcr-2015-211077. [PMID: 26424820 DOI: 10.1136/bcr-2015-211077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Dysplasia epiphysealis hemimelica is a rare developmental disorder which affects the epiphyses. We report a case of the disease located in the ankle joint, referred to our clinic with the initial misdiagnosis of a Salter-Harris 3 type fracture of the distal epiphysis of the tibia. After correct diagnosis, the patient was treated surgically with the excision of the cartilaginous masses. Taking an accurate medical history and performing adequate imaging studies is essential in diagnosing and treating this disease. Fracture-like epiphyseal configurations in patients with no history of injury should raise suspicion of periarticular developmental disorders.
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Maheshwari AV, Pitcher JD. Intraarticular osteochondroma of the knee. Indian J Orthop 2015; 49:260-1. [PMID: 26015620 PMCID: PMC4436497 DOI: 10.4103/0019-5413.152547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Aditya V Maheshwari
- Department of Orthopaedics and Rehabilitation, SUNY Downstate Medical Center, 450 Clarkson Ave, Brooklyn, New York,Address for correspondence: Dr. Aditya V. Maheshwari, Director, Musculoskeletal Oncology and Adult Reconstructive Surgery, Department of Orthopaedics and Rehabilitation, SUNY Downstate Medical Center, 450 Clarkson Ave, Box 30, Brooklyn, NY 11203, USA. E-mail:
| | - J David Pitcher
- Department of Orthopaedics, Miami V.A. Medical Center, Miami, FL, USA
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Baumfeld D, Pires R, Macedo B, Abreu-E-Silva G, Alves T, Raduan F, Nery C. Trevor Disease (Hemimelic Epiphyseal Displasia): 12-year Follow-up Case Report and Literature Review. Ann Med Health Sci Res 2014; 4:S9-S13. [PMID: 25031921 PMCID: PMC4083712 DOI: 10.4103/2141-9248.131689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Trevor disease or hemimelic epiphyseal dysplasia is a rare skeletal developmental disorder characterized by asymmetric overgrowth of cartilage in the epiphyses. Histologically, it is an epiphysis osteochondroma. The symptom onset occurs primarily during childhood. Males are 3 times more affected than females. The most common symptom is a painless bony mass around the ankle or knee, followed by swelling, restricted range of motion and deformity. Imaging diagnosis is based on plain radiographs, computed tomography scans and magnetic resonance imaging. Treatment depends on the deformities, symptoms, location and amount of epiphysis involvement. Asymptomatic patients require no treatment. When no deformities are identified, simple mass excision is the treatment choice. If the mass causes epiphyses asymmetry, resection must be combined with osteotomies. The present study reports a case of Trevor disease in a female patient with 12-year follow-up. A general review of Trevor disease was also performed.
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Affiliation(s)
- Ds Baumfeld
- Department of Orthopedic and Traumatology, Felício Rocho Hospital, Belo Horizonte, Minas Gerais, Brazil
| | - Res Pires
- Department of Orthopedic and Traumatology, Felício Rocho Hospital, Belo Horizonte, Minas Gerais, Brazil
| | - Bd Macedo
- Department of Orthopedic and Traumatology, Felício Rocho Hospital, Belo Horizonte, Minas Gerais, Brazil
| | - Gmd Abreu-E-Silva
- Department of Orthopedic and Traumatology, Felício Rocho Hospital, Belo Horizonte, Minas Gerais, Brazil
| | - Ta Alves
- Department of Orthopedic and Traumatology, Felício Rocho Hospital, Belo Horizonte, Minas Gerais, Brazil
| | - Fc Raduan
- Department of Orthopedic and Traumatology, Federal University of São Paulo, São Paulo, Brazil
| | - Cads Nery
- Department of Orthopedic and Traumatology, Federal University of São Paulo, São Paulo, Brazil
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19
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Trevor's Disease: A Literature Review regarding Classification, Treatment, and Prognosis apropos of a Case. Case Rep Orthop 2014; 2014:940360. [PMID: 25054073 PMCID: PMC4094880 DOI: 10.1155/2014/940360] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 06/05/2014] [Indexed: 11/17/2022] Open
Abstract
Background. Dysplasia epiphysealis hemimelica (DEH) is rare and its main characteristic is osteochondromas of the epiphysis of long bones. Methods. We report a case of DEH of the ankle in an 8-year-old boy that was resected in 2005. Additionally we collect all the reported cases of DEH. The literature is reviewed regarding the treatment, prognosis, long term function, and patterns and areas affected by DEH. Results. In our case no complications were noted and our patient remains asymptomatic. Reviewing the literature we found that 73 authors have reported 144 cases from 1926 to 2013. We propose and describe a new classification that correlates with prognosis. According to our classification DEH is classified as types 1 with single lower limb involvement, 2 with multiple lower limb, 3 with single upper limb, 4 with multiple upper limb, 5 with upper and lower limb, and 6 with spine. Conclusions. All single lesions should be followed up and if indicated a whole body nuclear bone scan can be useful in identifying the existence of multiple affected joints. Type 1 lesions have better prognosis than 2 and have less chances of developing OA even if not resected. Resection, even if partial, can be a successful treatment for DEH.
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20
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Jaimes C, Chauvin NA, Delgado J, Jaramillo D. MR Imaging of Normal Epiphyseal Development and Common Epiphyseal Disorders. Radiographics 2014; 34:449-71. [DOI: 10.1148/rg.342135070] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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21
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Satija B, Kumar S, Kapoor S, Pawar I. Dysplasia epiphysealis hemimelica of talus mimicking posterior ankle impingement syndrome in a young male: a case report with review of the literature. J Foot Ankle Surg 2013; 52:518-22. [PMID: 23669004 DOI: 10.1053/j.jfas.2013.03.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Indexed: 02/03/2023]
Abstract
Dysplasia epiphysealis hemimelica is a rare skeletal developmental disorder representing an osteocartilaginous tumor arising from 1 or more epiphyses during childhood. We report a case of a young male who presented with complaints of pain and swelling in the posteromedial aspect of the left ankle with the clinical diagnosis of posterior impingement syndrome. Imaging studies, including radiography, computed tomography, and magnetic resonance imaging, suggested the possibility of localized juxta-articular dysplasia epiphysealis hemimelica arising from the talus. The patient was successfully treated by surgical excision. The postoperative histologic findings were consistent with osteochondroma. This case report emphasizes the possibility of dysplasia epiphysealis hemimelica in the differential diagnosis of impingement syndromes around the ankle. The aim of the present study was to familiarize clinicians with this rare entity, because the number of documented cases has been increasing.
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Affiliation(s)
- Bhawna Satija
- Department Radiology, ESIH and Post Graduate Institute of Medical Science and Research, Basaidarapur, New Delhi, India
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22
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Kircher J, Westhoff B, Bittersohl B, Ziskoven C, Krauspe R. A rare case of Trevor's disease (dysplasia epiphysealis hemimelica) in the elbow. J Shoulder Elbow Surg 2013. [PMID: 23206405 DOI: 10.1016/j.jse.2012.10.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jörn Kircher
- Department of Orthopedics, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
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23
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Silveira RBD, Lopes FAR, Reis ALB, Granzotto E, Oliveira AGD. Displasia epifisária hemimélica (doença de Trevor-Fairbank): relato de caso. Radiol Bras 2013. [DOI: 10.1590/s0100-39842013000100016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A displasia epifisária hemimélica é uma doença benigna rara (incidência de 1:1.000.000), caracterizada por um crescimento osteocondral decorrente de uma ou mais epífises. Em geral a idade de início é entre 2 e 14 anos. Os achados característicos dos exames de imagem são suficientes para o diagnóstico. A excisão cirúrgica da lesão só é indicada caso haja limitação funcional.
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Affiliation(s)
| | | | | | - Enrico Granzotto
- Colégio Brasileiro de Radiologia e Diagnóstico por Imagem; Hospital Santa Casa de Misericórdia de Pelotas, Brasil
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24
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Tyler PA, Rajeswaran G, Saifuddin A. Imaging of dysplasia epiphysealis hemimelica (Trevor's disease). Clin Radiol 2012; 68:415-21. [PMID: 23040212 DOI: 10.1016/j.crad.2012.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 07/28/2012] [Accepted: 08/03/2012] [Indexed: 10/27/2022]
Abstract
Dysplasia epiphysealis hemimelica (DEH; synonyms; Trevor's or Trevor Fairbank disease) is a rare developmental disorder of the skeleton characterized by asymmetric osteochondral overgrowth of the cartilage of a medial or lateral epiphysis or epiphyseal equivalent. Imaging plays an important role in the diagnosis and management of DEH and in assessing the need for biopsy to differentiate it from more sinister diseases. There is no recent comprehensive review of the imaging of DEH and the purpose of this article is to describe the modern radiological manifestations of DEH.
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Affiliation(s)
- P A Tyler
- Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, UK.
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25
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Struijs PAA, Kerkhoffs GMMJ, Besselaar PP. Treatment of dysplasia epiphysealis hemimelica: a systematic review of published reports and a report of seven patients. J Foot Ankle Surg 2012; 51:620-6. [PMID: 22819617 DOI: 10.1053/j.jfas.2012.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Indexed: 02/03/2023]
Abstract
Dysplasia epiphysealis hemimelica is a rare entity. It is characterized by cartilage overgrowth in the epiphyses and is considered to be an epiphyseal osteochondroma. It usually presents during childhood and can cause pain and functional limitations. The aim of the present study was to describe the entity through our cases and published data and to present the results of our suggested treatment. A systematic search was performed to retrieve and describe all studies on dysplasia epiphysealis hemimelica. Studies were included if sufficient information on the patient characteristics, lesion location, treatment, and outcomes were described. In addition, we report on 7 of our patients. In our review, 48 studies were found, of which 42 could be included. Owing to the large heterogeneity in the studies, no pooling of data was performed. The studies included 138 patients with 255 lesions. Approximately 27% were female patients. The age at presentation ranged from 3 months to 66 years; however, in most, the entity was discovered before 8 years of age. No apparent guidelines were presented concerning the treatment strategy; however, most investigators performed resection because of pain or limitations in the range of motion. Most lesions were located in the ankle or foot (139 of 255). In our own cases, 5 of 7 patients experienced pain, limited range of motion, or activity restriction. The mean follow-up period was 4 years. Dysplasia epiphysealis hemimelica is a rare entity, occurring predominantly in the lower extremity of in young male patients. Its aggressive growth warrants aggressive treatment in the case of pain or functional or range of motion limitations.
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Affiliation(s)
- P A A Struijs
- Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
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26
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MRI of congenital and developmental abnormalities of the knee. Clin Radiol 2012; 67:1198-206. [PMID: 22608704 DOI: 10.1016/j.crad.2012.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 03/14/2012] [Accepted: 03/16/2012] [Indexed: 01/15/2023]
Abstract
The knee joint is the one of the most common locations for congenital and developmental musculoskeletal abnormalities. Initial imaging of the knee joint should always begin with conventional radiographs. However, evaluation of the bone marrow, cartilaginous, ligamentous, and other soft-tissue components of the knee joint are better characterized with magnetic resonance imaging (MRI). We present the MRI findings of prevalent congenital and developmental abnormalities in the paediatric knee with particular emphasis on the components of the growing skeleton.
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27
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Volders D, Vandevenne J, Van de Casseye W. Trevor's disease and whole-body MRI. Eur J Radiol 2011; 79:363-4. [DOI: 10.1016/j.ejrad.2010.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 02/21/2010] [Accepted: 03/04/2010] [Indexed: 11/26/2022]
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28
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Gokkus K, Aydin AT, Uyan A, Cengiz M. Dysplasia epiphysealis hemimelica of the ankle joint: a case report. J Orthop Surg (Hong Kong) 2011; 19:254-6. [PMID: 21857058 DOI: 10.1177/230949901101900227] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Dysplasia epiphysealis hemimelica is a rare non-hereditary epiphyseal disease that mimics synovial chondromatosis of the joints. The disease mainly targets long bones of the lower extremities and tarsal bones. We report one such case manifesting in the lateral tibia of a 13-year-old boy. He presented with a 7-month history of pain and a bony mass (3x4 cm) at the right ankle. The mass restricted ankle dorsiflexion over the lateral malleolar area. It was ossific with a lobulated appearance and reached the marrow with the underlying epiphysis and adjacent bones. The mass was excised completely from the epiphysis. The detached syndesmos was sutured anatomically.
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Affiliation(s)
- Kemal Gokkus
- Orthopedic Department, Antalya Memorial Hospital, Antalya, Turkey.
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29
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Mann SA, Andrews G, Forster BB, Malfair D, Prasad N. Answer to Case of the Month #160. Can Assoc Radiol J 2010; 61:58-61. [DOI: 10.1016/j.carj.2009.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Sumeer A. Mann
- College of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Gordon Andrews
- Department of Radiology, University of British Columbia, UBC Hospital, Vancouver, British Columbia, Canada
| | - Bruce B. Forster
- Department of Radiology, University of British Columbia, UBC Hospital, Vancouver, British Columbia, Canada
| | - David Malfair
- Department of Radiology, University of British Columbia, UBC Hospital, Vancouver, British Columbia, Canada
| | - Navin Prasad
- Department of Family Medicine, University of British Columbia, Allan McGavin Sports Medicine Centre, Vancouver, British Columbia, Canada
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30
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Bahk WJ, Lee HY, Kang YK, Park JM, Chun KA, Chung YG. Dysplasia epiphysealis hemimelica: radiographic and magnetic resonance imaging features and clinical outcome of complete and incomplete resection. Skeletal Radiol 2010; 39:85-90. [PMID: 19813010 DOI: 10.1007/s00256-009-0803-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 08/28/2009] [Accepted: 09/07/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The objectives of this communication were to discuss radiographic and magnetic resonance (MR) imaging manifestations and clinical outcome after complete and incomplete resection of the mass of dysplasia epiphysealis hemimelica (DEH). MATERIALS AND METHODS Clinical records, radiographs, and MR images of eight patients with DEH were retrospectively examined. Six patients were treated by complete excision of the lesional mass, and two patients were treated by incomplete resection at our University Hospitals during the period from 1980 to 2006. RESULTS We found that, unlike in osteochondroma, DEH was radiographically not clearly separable from the underlying or host bone with preserved cortical bone and marrow continuity. The finding in the talus distinguished DEH from (osteochondroma-like) parosteal osteosarcoma, in which a radiolucent demarcation line clearly separated the tumor from the host bone. The DEH mass had a well-defined low to intermediate signal intensity on T1-weighted images and an intermediate to high signal intensity on T2-weighted images, with irregularity of the articular surface. Simple excision was performed in all patients. The excision was complete in six patients and incomplete in two patients whose lesions was juxta-articular in the ankle and articular in the knee, respectively. The residual mass slowly absorbed and vanished, resulting in mild flaring of the affected portion of the epiphysis. No local recurrence or complication was seen in any of the eight patients. CONCLUSIONS Although the radiographic signs of DEH are characteristic, (osteochondroma-like) parosteal osteosarcoma should be differentiated from DEH when there is a radiolucent separation line between the mass and host bone in the talus. Simple excision was effective in the management of DEH if the deformity was not complicated. Incompletely excised masses resolved and vanished with time.
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Affiliation(s)
- Won-Jong Bahk
- The Musculoskeletal Oncology Group, The Catholic University of Korea, Uijungbu, Gyunggido, Korea.
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31
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Perl M, Brenner RE, Lippacher S, Nelitz M. Dysplasia epiphysealis hemimelica: a case report with novel pathophysiologic aspects. Clin Orthop Relat Res 2009; 467:2472-8. [PMID: 19526273 PMCID: PMC2866937 DOI: 10.1007/s11999-009-0925-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Accepted: 05/28/2009] [Indexed: 01/31/2023]
Abstract
Dysplasia epiphysealis hemimelica (DEH) is a rare developmental disorder. The underlying pathophysiology is largely unclear. Its diagnosis is based on clinical findings and may be difficult due to its low incidence and close relationship to other disorders such as osteochondroma. We describe a 13-year-old boy who presented with a unilateral lesion of the left medial femoral condyle and left ankle. In addition to standard diagnostic tools such as radiographs and MRI, arthroscopy-guided biopsy was performed; histologic/immunohistochemical findings from cartilage-bone specimens confirmed the diagnosis and provided novel information toward a disease mechanism. The cellular phenotype of clustered chondrocytes exhibited characteristics of chondroprogenitor cells and terminally differentiated cells, suggesting dysregulation of resident progenitor cells. No other surgery was performed and during a 2 year period, we observed spontaneous ossification of the lesion associated with decreased joint impairment. Immunohistochemical analysis of the lesion provided a more accurate diagnosis and may contribute to unraveling potential novel mechanisms involved in its pathogenesis.
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Affiliation(s)
- Mario Perl
- Department of Orthopaedics, University of Ulm Medical School, Ulm, Germany ,Department of Traumatology, Hand- and Reconstructive Surgery, University of Ulm Medical School, Ulm, Germany
| | - Rolf E. Brenner
- Division for Biochemistry of Joint and Connective Tissue Diseases, Department of Orthopaedics, University of Ulm Medical School, Oberer Eselsberg 45, 89081 Ulm, Germany
| | - Sabine Lippacher
- Department of Orthopaedics, University of Ulm Medical School, Ulm, Germany
| | - Manfred Nelitz
- Department of Orthopaedics, University of Ulm Medical School, Ulm, Germany
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